Most Prostate Cancer Patients Don't Die From the Disease: Study

FRIDAY, July 27 -- Men with prostate cancer are more likely to die from other conditions, such as heart disease, than from their cancer, a new study finds.

Living a healthy lifestyle that helps prevent chronic diseases can prolong life even among men with prostate cancer, the researchers added.

"Our study is the first to analyze specific causes of death among men with prostate cancer," said lead researcher Mara Epstein, a postdoctoral researcher at the Harvard School of Public Health in Boston.

Most men who died from prostate cancer over several decades of the study were men diagnosed when they were older or diagnosed before the advent of screening for prostate-specific antigen (PSA), she noted.

"We hope the study will have an impact on the clinical management of men who receive a diagnosis of prostate cancer," Epstein said.

"We hope it will encourage physicians to use the diagnosis as a teachable moment to encourage men to modify lifestyle factors, like losing weight, increasing physical activity and stopping smoking," she explained. "We believe that adopting a healthier lifestyle may reduce a man's risk of other chronic medical conditions that ultimately account for more deaths among men with prostate cancer than the disease itself."

The report was published July 25 in the online edition of the Journal of the National Cancer Institute.

For the study, Epstein's team used the U.S. Surveillance, Epidemiology, and End Results Program and the Swedish Cancer and Cause of Death registries to collected data on the causes of death among more than 700,000 men.

U.S. deaths were for 1973 through 2008; for Swedish men it was 1961 through 2008, the team noted.

Over these periods, 52 percent of the Swedish men with prostate cancer died, as did 30 percent of American men with prostate cancer in the study.

Of these deaths, however, only 35 percent of the Swedish men died directly from prostate cancer and only 16 percent of American men died from the disease itself, the investigators found.

In addition, as the study continued, fewer men died from prostate cancer while deaths from heart disease remained the same.

By the last five years of the study, 29 percent of Swedish men with prostate cancer died from it as did 11 percent of American men, the researchers calculated.

Deaths from prostate cancer varied by age and year of diagnosis. The most deaths were among older men and among men diagnosed before screening for PSA began, they added.

With PSA screening, prostate cancer was diagnosed early and more low-risk cancers were identified, the researchers explained.

Dr. Durado Brooks, director of prostate and colon cancer at the American Cancer Society, said that "this is a lot of reinforcement for a lot of information we already know about. Many more men die with prostate cancer than from prostate cancer."

Brooks added that "prostate cancer is largely a disease of older men, and many of the men who are diagnosed have other medical problems that end up killing them."

Most prostate cancers are slow-growing, and therefore not lethal. In a recent study it was reported that only about 10 percent of men die from prostate cancer whether they receive treatment or not, he noted.

For Brooks, these findings argue against PSA screening, which too often "leads down the path of unnecessary treatment."

"Men should understand that not every prostate cancer needs to be found and every prostate cancer that's found does not necessarily need to be treated," he said.

Another expert, Dr. Louis Kavoussi, chairman of urology at North Shore-LIJ Health System, The Arthur Smith Institute for Urology in Lake Success, N.Y., added that "prostate cancer does kill and if you pick it up early, it can be treated."

The problem with PSA screening is that too many men are treated when they don't have to be, he said. "It's not bad to detect prostate cancer. The bad thing is that you treat everybody," Kavoussi suggested.

"We need to become smarter about who actually needs to be treated and when people need to be treated," he added.

Many men don't need to be screened, Kavoussi said. Those who should be screened are men with a family history of prostate cancer, blacks and anyone else at high risk, he noted.